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Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E? as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure.Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E?) by TDI (E/E?) was calculated.Results: The ratio of E/E? in diastolic group was 13.4�9 and in systolic group it was 13.7�2. The mean LVEDP in diastolic heart failure patients was 14.3�5 and 14.2�9 in systolic heart failure patients. The ratio of E/E? showed a better correlation with LVEDP. E/E? <8 accurately predicted normal LVEDP, and E/E? >15 identified increased LVEDP ?15mmHg.Conclusions: E/E? is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E? seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E?, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.
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Background: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. Objectives: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. Methods: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. Results: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. Conclusion: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.
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Objective To assess the value of plasma level of cystatin C(Cyst-C)and carotid artery plaque score(PS)in predicting significant coronary artery disease(SCAD)in patients with chest pain. Methods A total of 192 patients with chest pain were involved retrospectively. According to the coronary angiography results ,the patients were divided into groups of SCAD (n = 128) and non-significant coronary artery disease (NSCAD , n = 64). Analyses were done to discuss the association of Cyst-C and PS with SCAD and the predictive value of Cyst-C and PS for SCAD. Results Logistic regression analysis demonstrated that Cyst-C and PS were independent predictors of SCAD. The odds ratios(OR)associated with the Cyst-C(each 1 mg/L)and PS(each 1 mm)for prediction of SCAD were 1.329 and 1.197,respectively. The areas under the receiver-operating characteristic curves(AUC)for the Cyst-C and the PS to predict the SCAD were 0.654 and 0.688,respectively. The combination of Cyst-C and PS increased the AUC to 0.742. The optimal cut-off value of Cyst-C was 0.95 mg/L and had a sensitivity of 72.3% for SCAD. Similarly,the optimal cut-off level of PS was 3mm which presented a sensitivity of 70.7%. A Cyst-C ≥ 0.95 mg/L and a PS ≥ 3 mm had negative predictive values of 46.3% and 48.3%,respectively,for SCAD. By combining Cyst-C with PS ,the sensitivity and negative predictive value increased to 83.6%and 62.5%, respectively. Conclusions Cyst-C and PS are both correlated with SCAD. They are independent predictive factors for SCAD in patients with chest pain. Combination of Cyst-C and PS can improve the predictability ,which may increase the reliability of screening SCAD before cardiac catheterization.
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Objective To study the value of epidemiology-based mortality score,a novel scoring system,in in-hospital adult patients with status epilepticus (SE) for predicting mortality,and to compare it with the status epilepticus severity score (STESS).Methods The clinical and electroencephalography data of 54 adult patients with SE admitted from June 2013 to June 2016 were derived from a prospective SE database of Zhejiang Provincial Hospital of Traditional Chinese Medicine.The outcome was defined as inhospital death or survival at discharge.When the receiver-operating characteristic (ROC) curves were made,the area under ROC (AUC) and the optimal cutoff value were calculated.Fisher's linear discriminant function analysis was conducted with the outcome as dependent variable and the scores as independent variables.Results Among 54 patients with SE recruited into the study,13 (24.10 ％) died in the hospital.The ROC curve for prediction of in-hospital death based on the STESS had a AUC of 0.705with an optimal cutoff value for discrimination (best match for both sensitivity (0.77) and specificity (0.56) to be ≥ 3 points.The AUC based on the EMSE was 0.800 with an optimal cutoff value for discrimination (best match for both sensitivity (0.92) and specificity (0.61) to be ≥ 79 points.Three elements added in combination with EMSE system (etiology-age-comorbidity,EMSE-EAC) predicted inhospital mortality with the best match for both sensitivity (1.00) and specificity (0.56) as the optimal cutoff point was ≥32 points,and the AUC was 0.814.Four elements added in combination with EMSE system (etiology-age-comorbidity-EEG,EMSE-EACE) predicted in-hospital mortality with the best match for both sensitivity (0.77) and specificity (0.98) as the optimal cutoff point was ≥71 points with an AUC of 0.925.The AUC of EMSE-EACE was larger than that of both STESS and EMSE (Both P ＜ 0.01).Discriminant equations were found by Fisher linear discriminant analysis.The rates of accuracy of the equation for predicting patients' prognosis were 44.44％ (STESS),62.96％ (EMSE),70.37％ (EMSE-EAC) and 81.48％ (EMSE-EACE) respectively,suggesting that the equations of EMSE,EMSE-EAC and EMSE-EACE have superior stability.Conclusions The EMSE is an effective clinical scoring system that focuses on individual mortality.EMSE-EACE is superior over both STESS and EMSE in the prediction of inhospital death.
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Objective To study the value of epidemiology-based mortality score,a novel scoring system,in in-hospital adult patients with status epilepticus (SE) for predicting mortality,and to compare it with the status epilepticus severity score (STESS).Methods The clinical and electroencephalography data of 54 adult patients with SE admitted from June 2013 to June 2016 were derived from a prospective SE database of Zhejiang Provincial Hospital of Traditional Chinese Medicine.The outcome was defined as inhospital death or survival at discharge.When the receiver-operating characteristic (ROC) curves were made,the area under ROC (AUC) and the optimal cutoff value were calculated.Fisher's linear discriminant function analysis was conducted with the outcome as dependent variable and the scores as independent variables.Results Among 54 patients with SE recruited into the study,13 (24.10 ％) died in the hospital.The ROC curve for prediction of in-hospital death based on the STESS had a AUC of 0.705with an optimal cutoff value for discrimination (best match for both sensitivity (0.77) and specificity (0.56) to be ≥ 3 points.The AUC based on the EMSE was 0.800 with an optimal cutoff value for discrimination (best match for both sensitivity (0.92) and specificity (0.61) to be ≥ 79 points.Three elements added in combination with EMSE system (etiology-age-comorbidity,EMSE-EAC) predicted inhospital mortality with the best match for both sensitivity (1.00) and specificity (0.56) as the optimal cutoff point was ≥32 points,and the AUC was 0.814.Four elements added in combination with EMSE system (etiology-age-comorbidity-EEG,EMSE-EACE) predicted in-hospital mortality with the best match for both sensitivity (0.77) and specificity (0.98) as the optimal cutoff point was ≥71 points with an AUC of 0.925.The AUC of EMSE-EACE was larger than that of both STESS and EMSE (Both P ＜ 0.01).Discriminant equations were found by Fisher linear discriminant analysis.The rates of accuracy of the equation for predicting patients' prognosis were 44.44％ (STESS),62.96％ (EMSE),70.37％ (EMSE-EAC) and 81.48％ (EMSE-EACE) respectively,suggesting that the equations of EMSE,EMSE-EAC and EMSE-EACE have superior stability.Conclusions The EMSE is an effective clinical scoring system that focuses on individual mortality.EMSE-EACE is superior over both STESS and EMSE in the prediction of inhospital death.
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Background Glaucoma is characterized by loss of retinal ganglion cells (RGCs) followed by visual field defects.Spectral domain OCT(SD-OCT) enabled more precise and quantitative assessments of macular ganglion cell complex (GCC) thickness.Objective This study was to evaluate the diagnostic ability of GCC thickness in identifying primary open angle glaucoma (POAG).Methods A prospective study was performed.Seventy POAG patients and 30 healthy volunteers were enrolled in Beijing Tongren Hospital from November 2015 to April 2016.Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were measured with RTVue SD-OCT,and Humphrey perimetry was performed on the eyes.The patients were assigned to the early stage POAG group,advanced POAG group and later stage POAG group based on the mean defect (MD) of visual field.The average,superior,inferior GCC and RNFL,focal loss volume (FLV),and global loss volume (GLV) were measured and compared among the groups.The correlations between GCC thickness or RNFL thickness with MD were evaluated in the POAG eyes.The discrimination capabilities of GCC thickness or RNFL thickness were assessed and compared by using areas under the receiver operating characteristic (ROC) curves (AUC).Results Compared with the normal control group,the average,superior,inferior GCC thickness and RNFL values were evidently reduced,the FLV and GLV were significantly increased in the early stage POAG group,advanced POAG group and later stage POAG group (all at P＜0.001).Compared with the early stage POAG group,the average GCC and RNFL thickness values were significantly reduced,and GLV was increased in the advanced POAG group and later stage POAG group (all at P＜0.05).In the later stage POAG group,superior RNFL was thinner than that in the early stage POAG group (P =0.003).The superior GCC value were lower in the later stage POAG group than that in the early stage POAG group and advanced POAG group (all at P＜0.001).Compared with the early stage POAG group,the inferior GCC and RNFL thicknesses were decreased and the FLV was increased in the advanced POAG group and the later stage POAG group (all at P≤0.01).Linear positive correlations were found between average GCC,superior GCC,inferior GCC,average RNFL,superior RNFL or inferior RNFL and MD (r =0.624,0.583,0.601,0.571,0.447,0.537,all at P＜0.001),and the positive correlations were also seen between average GCC and average RNFL,between superior GCC and superior RNFL or between inferior GCC and inferior RNFL (r =0.648,0.630,0.602,all at P＜0.001).The AUCs were 0.965,0.979,0.924,0.985,0.980,0.990,0.979 and 0.992 in the average GCC,superior GCC,inferior GCC,FLV,GLV,average RNFL,superior RNFL and inferior RNFL,with the largest AUCs in the FLV and inferior RNFL thickness.No significant difference was found in the AUC between FLV and inferior RNFL thickness (P＞0.05).Conclusions Inferior GCC is more susceptible to glaucomatous damage.FLV and GLV from GCC pattern parameters are sensitive indicators for diagnosis of POAG.GCC thickness could be a valid structural parameter for detecting glaucoma and can be used as a marker in glaucoma assessment.
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Objective To study the diagnostic value of fractional exhaled nitric oxide(FeNO)in non-typical bronchial asthma.Methods Ninety-five patients with unknown-cause respiratory symptoms including wheezing,cough and breathlessness were enrolled.FeNO was measured by nitric oxide analyzer.The clinical symptoms and bronchial bronchodilator test were defined as golden standard for asthma diagnosis.The diagnostic value of FeNO was assessed and the optimal operating point of FeNO test was determined by means of the receiver operating characteristic(ROC)curve.Results Among 95 patients,44 cases were diagnosed as asthma,51 cases were diagnosed as non-asthma.The level of FeNO of asthma patients were higher than that of non-asthma patients[(55.2±14.0)nmol/L vs.(18.9±5.2)nmol/L,P＜0.01].A non-linear correlation of FeNO with FEV1％ was revealed in the cases with asthma(r=-0.162,P＞0.05).Area under ROC curve was 0.858.The optimal diagnostic cut off point was 36 nmol/L which was capable of differentiating asthma and non-asthma with sensitivity of 80.2％,specificity of 79.5％,positive predictive value of 85.4％,negative predictive value of 83.3％ and accuracy of 85.9％.Conclusions FeNO test may be helpful in the diagnosis of non-typical asthma with high sensitivity and specificity,which can also improve the diagnostic effectiveness and avoid misdiagnosis,missed diagnosis when combined with lung function test.
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Objective To determine the diagnostic value of fractional exhaled nitric (FeNO) measurement in diagnosis of bronchial asthma. Methods The patients with unkown-cause respiratory symptoms including wheezing, cough, and breathlessness were enrolled from August to September in 2008. FeNO was measured by nitric oxide analyzer (NIOX; Aerocrine AB; Solna, Sweden). Bronchial challenge test (BCT) or bronchodilator test was defined as golden standard for asthma diagnosis. The value of FeNO was assessed and the optimal operating point of FeNO testing was determined by the means of the receiver operating characteristic (ROC) curves. Results A total of 101 patients were enrolled, in which 48 cases were diagnosed as asthma by positive yield in BCT (in 38 cases) or bronchodilator test (in 10 cases). The severity of airway hyperresponsiveness (AHR) judged by BCT was mild in 15 cases, moderate in 15 cases and severe in 8 cases. The levels of FeNO of asthma group were higher than those of non-asthma group [(68.19±43.00) pph vs (19.52±10.60) ppb, P < 0.05]. A linear correlation of FeNO with lnPD20 FEV1 was revealed in the cases with AHR. Area under ROC curve was 0.9. The optimal diagnostic cutoff point was 36.5 ppb which was capable of differentiating asthma and non-asthma with sensitivity of 92.7%, specificity of 83.3%, positive predictive value of 79.17% , negative predictive value of 94.34% and accuracy of 87.13%. Conclusion FeNO test may be helpful in the diagnosis of asthma with high sensitivity and specificity.
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@#ObjectiveTo examine the relationship between ankle brachial index (ABI) and the extent of coronary stenosis and evaluate the usefulness of ABI to predict the extent of coronary stenosis in old patients.Methods118 patients with coronary angiography were examined by ABI and hemostatic factors evaluation in addition to history collection.ResultsABI was inversely and significantly associated with Gensini score. ABI reduced significantly (P<0.001) in the patients with 3-vessel or left main coronary artery disease (CAD). But there were no significant differences in ABI among the patients with no CAD, 1-vessel or 2-vessel CAD. The corresponding area under the ROC curve was 0.75±0.045, with 95% CI=0.67～0.84 (P<0.001) in ABI in 3-vessel or left main CAD. When ABI≤0.9, it had a relatively high specificity (89.1%) and sensitivity (55.6%) for predicting the presence of 3-vessel disease or left main CAD.ConclusionIn the old patients, ABI is inversely and significantly associated with the extent of coronary stenosis, and ABI≤0.9 has a relatively high specificity and sensitivity for predicting the presence of 3-vessel or left main CAD.